75例重型颅脑损伤儿童肢体肌力影响因素临床分析

Clinical analysis of limb myodynamia in 75 children with severe craniocerebral injury

摘要:

目的：探讨重型颅脑损伤儿童伤后肢体肌力异常的特点及其影响因素。方法：回顾性分析2012年1月1日至2014年12月31日本院神经外科收治的75例重型颅脑损伤患儿肢体肌力异常发生率及其影响因素。对伤后意识障碍持续时间、康复介入时间与肢体肌力异常率的回归相关性进行分析。运用Bonferroni校正的配对卡方检验分析意识恢复、神经外科治疗结束及出院3个月3个时间点肌力异常率；运用两独立样本秩和检验和logistic回归分析检测意识障碍时间和康复介入时间对患儿住院时间长短和出院3个月时肌力恢复的影响。结果：本组患儿上述3个时间点的肌力异常率分别为46.7%、28.0%和16.4%；运动功能区是否损伤只在意识恢复时对肌力的影响有差异，结果有统计学意义（P=0.09）；意识障碍时间>4 d更易导致患儿在意识恢复时（P=0.005）、神经外科治疗结束时（P=0.001）和出院3个月时（P=0.021）肢体肌力异常的发生；急性期治疗结束后进行康复容易导致肢体肌力异常的发生，一直缺乏康复对肢体肌力异常的影响更加明显（P=0.034）。意识障碍时间短的患儿相对于时间长的患儿，OR=0.674，95%CI=0.219~0.674；康复介入时间早的患儿相对于介入晚的患儿，OR=0.437，95%CI=0.117~0.538；回归模型均有显著性（P﹤0.05）。结论：重型颅脑损伤儿童伤后肢体肌力异常发生率较高，意识障碍时间长、康复介入时间晚等是导致肢体肌力降低的主要原因，临床应早期加强促醒和康复治疗。

Abstract:

Objective：To investigate the characteristics and influencing factors of limb myodynamia in children with severe head in－jury. Methods：A retrospective analysis of 75 children with severe craniocerebral injury in the neurosurgery department of Children’s Hospital of Chongqing Medical University from 2012 to 2014 was conducted. The duration of consciousness obstacle，the time of reha－bilitation intervention and the abnormal rate of limb myodynamia were analyzed. Bonferroni-McNemar-Bowker test was used to ana－lyze the abnormal rate of myodynamia at the time points of recovery of consciousness，neurosurgery at the end of treatment，and dis－charge after 3 months. The effects of the duration of consciousness obstacle and the time of rehabilitation intervention on myodynamia and hospitalization duration of patients with rank were analyzed by rank-sum test and logistic regression. Results：The muscle abnormal rates at three time points mentioned above were 46.7%，27.9% and 16.0% respectively. Movement function damage exerted effect on myodynamia only when recovering consciousness（P=0.09）. Consciousness obstacle > 4 days were more likely to induce myodynamia abnormal at the time points of recovery of consciousness（P=0.005），neurosurgery at the end of treatment（P=0.001），and 3 months af－ter discharge（P=0.021）. Rehabilitation treatment at the end of the treatment was likely to induce myodynamia and delayed rehabili－tation would exert more serious effect on myodynamia（P=0.034）. The OR value was 0.674 and 95% confidence interval was 0.219 to 0.219 among children with short time of consciousness obstacle. The OR value was 0.437 and 95% confidence interval was 0.117 to 0.538 among children with early rehabilitation intervention. The regression model was of significant difference（P<0.05）. Con－clusion：The reasonable nursing for children with serious brain injury at early time is very important，which is consisted of con－sciousness-promoted rehabilitation and psychological interven－tion. We should promote wake at early satgeand rehabilitation.